Gaps in health law dental coverage

The health care law was supposed to go a long way toward getting more kids access to dental care. But as it stands now, the effort may fall short.

Children’s dental coverage is considered an “essential health benefit” under the law. But the way it’s likely to be offered — through separate dental policies with no penalties for parents who don’t get them — has dentists and child health advocates worried.

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Administration officials haven’t said much yet about how the dental coverage will work. But what they have spelled out so far has dentists and vendors of dental health plans scratching their heads — and hoping that it’s sorted out in a batch of final regulations due out shortly, perhaps later this month.

If not, Americans could be less inclined to buy dental coverage for their children or for themselves depending on where they buy their insurance.

Here’s how the problem unfolds inside the new health insurance exchanges. Plans have to be certified to sell in the exchanges, and they have to cover the essential benefits. But the administration has said they can be certified without the pediatric dental coverage — as long as there’s a stand-alone pediatric dental plan that people can purchase in the exchange as an add-on.

So a family could buy an approved health plan — without tacking on the pediatric dental coverage — and not face any kind of penalty or fine.

At least that’s how the Center for Consumer Information and Insurance Oversight laid out the policy to dental insurers in a Dec. 5 call, according to two participants.

“It caused a collective gasp,” said Chad Olson, a lobbyist for the Delta Dental Plans Association.

With the penalty removed, the low-income Americans who shop on the exchanges will be more likely to forgo the pediatric dental coverage, even though many will be subsidized for their health and kids’ dental insurance.